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Is This Too Extreme?

denisescott's picture

For some reason, healthcare executives like to equate stuff in their lobby to person-centered care.  Player pianos. Coffee for visitors. Seating areas with plants. Leaders that were eager to tell me about how they are “doing” culture change have proudly presented each of these examples to me. Pathetic . . .

The greatest pianist, coffee or seating does not make up for the fact that most healthcare organizations deprive people of their dignity and individuality.

Extreme? . . . . . Perhaps. True? . . . .  Absolutely.

The idea of person-centered care is not new.  It has a long history in various levels of healthcare. Yet, somehow, the concept of person-centered care still struggles for the respect that clinical outcomes, quality measures and even financial results get.

But is what a person wants any less important than what a person needs?  

Don Berwick, former CMS Administrator, describes himself as an extremist in his article on patient-centered care. It is one of the best article I have read on the subject.  In the article, Berwick addresses common objections that I often see. One objection is, “What do we do if a residents wants something crazy or foolish?”

In a training seminar that I recently conducted, a staff member asked, “Do people just get anything they want now?” The answer is “Yes!” On rare occasions a “No” may be necessary. 

BUT we shouldn’t make blanket policies that affect everyone based on one situation.

As Berwick writes, “…rare occasions make for very bad rules for the usual occasions.” Recognize that person-centered care goes beyond customer service and aesthetics. It asks, “What do you need and want?”

It acts on the answer and then asks, “How could I do better?” Berwick shares some ways to bring patient-centered care alive:

Control - Give control over to residents and the loved ones they choose. Take over control rarely, and only with permission.

Transparency - Share outcomes, processes, and errors freely. Apologize when things go wrong.

Individualization - While the environment is important, the focus of culture change should be on creating systems that are adaptable to individuals.

Training - All staff should be equipped with the skills they need to support residents’ needs and wants.

What do YOU think? Is coffee in the lobby enough or should you say “yes” to everything a resident wants or needs? Is the answer somewhere in the middle or is that a slippery slope back to mediocrity?

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